Significance of hypotensive response during dobutamine stress echocardiography.

Background: In patients undergoing exercise testing a hypotensive response is associated with a poor prognosis. There is limited information regarding the prognostic significance of hypotension during dobutamine stress test. This study investigates the association between a severe hypotensive response during DSE and long-term prognosis.

Comparison of three-year clinical outcome of sirolimus- and paclitaxel-eluting stents versus bare metal stents in patients with ST-segment elevation myocardial infarction (from the RESEARCH and T-SEARCH Registries).

Sirolimus-eluting stents (SESs) recently proved to be superior to bare metal stents (BMSs) in decreasing the need for repeat revascularization in patients with ST-segment elevation myocardial infarction (STEMI) at 1 year. Whether this also holds for paclitaxel-eluting stents (PESs) is currently unclear and the long-term relatively efficacy of the 2 drug-eluting stents is currently unknown. We investigated the 3-year efficacy of SESs and PESs versus BMSs in patients with STEMI.

Reproducible coronary plaque quantification by multislice computed tomography.

Background: The aim of this study was to investigate reproducibility and accuracy of computer-assisted coronary plaque measurements by multislice computed tomography coronary angiography (QMSCT-CA).

Methods And Results: Forty-eight patients undergoing MSCT-CA and coronary arteriography for symptomatic coronary artery disease and quantitative intravascular ultrasound (IVUS, QCU) were examined. Two investigators performed the QMSCT-CA twice and a third investigator performed the QCU, all blinded for each other's results.

Fatigue, depressive symptoms, and hopelessness as predictors of adverse clinical events following percutaneous coronary intervention with paclitaxel-eluting stents.

Objective: We investigated the relative effects of fatigue, depressive symptoms, and hopelessness on prognosis at 2-year follow-up in percutaneous coronary intervention (PCI) patients.

Methods: Consecutively admitted PCI patients (n=534) treated with paclitaxel-eluting stent as the default strategy completed the Maastricht Questionnaire (MQ) at baseline. Apart from an overall vital exhaustion score, the MQ also assesses fatigue (seven items; Cronbach's alpha=.

Type-D personality exerts a stable, adverse effect on vital exhaustion in PCI patients treated with paclitaxel-eluting stents.

Objective: Vital exhaustion is associated with the pathogenesis of cardiovascular disease (CVD), but its prevalence after percutaneous coronary intervention (PCI) with drug-eluting stent implantation, as well as the impact of personality on exhaustion, is not known. In PCI patients, we examined (a) the prevalence of exhaustion, (b) the impact of type-D personality on exhaustion over time, and (c) the clinical significance of type-D personality compared with gender and age as predictors of exhaustion.

Methods: Consecutive patients (n=419) with stable or unstable angina treated with PCI with drug-eluting stent implantation completed the Type-D Scale (DS14) at baseline and the Maastricht Questionnaire (which assesses exhaustion) at baseline and at 1 year.

Type-D personality and depressive symptoms predict anxiety 12 months post-percutaneous coronary intervention.

Background: We examined whether type-D personality exerts a stable effect on anxiety over time and the clinical relevance of type-D personality as a predictor of anxiety 12 months post-percutaneous coronary intervention (PCI).

Methods: Consecutive patients (n=416) with stable or unstable angina pectoris treated with PCI completed the Type-D Scale (DS14) at baseline and the Hospital Anxiety and Depression Scale (HADS) at baseline and 12 months.

Results: At baseline, 26% of the patients were anxious, with 67% of these patients still being anxious 12 months post-PCI (p<0.

Prognostic significance of akinesis becoming dyskinesis during dobutamine stress echocardiography.

Background: Akinesis becoming dyskinesis (AKBD) at high-dose dobutamine stress echocardiography (DSE) has been disregarded as a marker of myocardial ischemia. However, its prognostic significance is unknown.

Objectives: We sought to assess the long-term outcome of patients with AKBD during DSE.

Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study.

Background: Stent thrombosis is a safety concern associated with use of drug-eluting stents. Little is known about occurrence of stent thrombosis more than 1 year after implantation of such stents.

Methods: Between April, 2002, and Dec, 2005, 8146 patients underwent percutaneous coronary intervention with sirolimus-eluting stents (SES; n=3823) or paclitaxel-eluting stents (PES; n=4323) at two academic hospitals.

Adverse clinical events in patients treated with sirolimus-eluting stents: the impact of Type D personality.

Background: Little is known about the impact of psychological risk factors on cardiac prognosis in the drug-eluting stent era. We examined whether the distressed personality (Type D) moderates the effect of percutaneous coronary intervention with sirolimus-eluting stent implantation on adverse clinical events at 2-year follow-up. Type D is an emerging risk factor in patients with cardiovascular disease.

Effects of evening vs morning thyroxine ingestion on serum thyroid hormone profiles in hypothyroid patients.

Objective: Standard drug information resources recommend that l-thyroxine be taken half an hour before breakfast on an empty stomach, to prevent interference of its intestinal uptake by food or medication. We observed cases in which TSH levels improved markedly after changing the administration time of l-thyroxine to the late evening. We therefore conducted a pilot-study to investigate whether l-thyroxine administration at bedtime improves TSH and thyroid hormones, and whether the circadian rhythm of TSH remains intact.

The impact of transforming growth factor-beta1 gene polymorphism on end-stage renal failure after heart transplantation.

Background: Nephrotoxicity is a major side effect of calcineurin inhibitors (CNI). Earlier we reported 8% of our heart transplant recipients reaching end-stage renal failure (ESRF). Now, with an extended follow up of 20 years, we re-evaluated the development of ESRF and studied its influence on survival and the impact of polymorphisms in codon 10 and 25 of the promoter region of transforming growth factor (TGF)-beta on the risk of ESRF.

Type D personality is associated with impaired health-related quality of life 7 years following heart transplantation.

Objective: Health-related quality of life (HRQoL) following transplantation is gaining importance as an endpoint, but little is known about the role of normal personality traits as a determinant of HRQoL in this patient group. We investigated whether Type D personality (tendency to experience increased negative emotions paired with the nonexpression of these emotions) was associated with impaired HRQoL in heart transplant recipients.

Methods: Data were collected from all surviving heart transplant recipients >or=21 years of age (n=186) with a mean (S.

Anxiety enhances the detrimental effect of depressive symptoms on health status following percutaneous coronary intervention.

Objective: We examined whether anxiety has incremental value to depressive symptoms in predicting health status in patients undergoing percutaneous coronary intervention (PCI) treated in the drug-eluting stent era.

Methods: A series of consecutive patients (n=692) undergoing PCI as part of the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital registry completed the Hospital Anxiety and Depression Scale at 6 months and the Short-Form Health Survey (SF-36) at 6 and 12 months post-PCI.

Results: Of 692 patients, 471 (68.

Two-year clinical outcome after coronary stenting of small vessels using 2.25-mm sirolimus- and paclitaxel-eluting stents: insight into the RESEARCH and T-SEARCH registries.

Objectives: To evaluate long-term outcomes after drug-eluting stents (DES) implantation in small coronary vessels.

Background: Sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) have been reported to improve both the angiographic and clinical outcomes compared with bare metal stents even in 'real world' settings. Currently, no data is available on long-term outcomes after DES implantation in small vessels.

The long-term value of sirolimus- and paclitaxel-eluting stents over bare metal stents in patients with diabetes mellitus.

Aims: To investigate the outcome of a real world diabetic patient cohort treated with bare metal stents (BMS), sirolimus-, or paclitaxel-eluting stents (SES and PES, respectively). Due to the different mechanisms of action of both drugs it is currently unknown which device is the best option to treat these high-risk patients.

Methods And Results: The study compares the 2-year clinical outcome of 708 consecutive diabetic patients (25% insulin treated) treated with either a BMS (n = 252), a SES (n = 206), or a PES (n = 250), as part of the RESEARCH and T-SEARCH registries.

Impact of glomerular filtration rate on minor troponin T elevations for risk assessment in patients undergoing operation for abdominal aortic aneurysm or lower extremity arterial obstruction.

Debate surrounds the impact of renal function on the prognostic value of minor troponin T release in vascular surgery patients. The objective of this study was to assess the long-term prognostic value of minor degrees of troponin T release in patients who undergo major vascular surgery, especially those with concomitant renal dysfunction. Survivors of major noncardiac vascular surgery (n = 558) were preoperatively screened for cardiac risk factors and renal function.

Cost-effectiveness of the unrestricted use of sirolimus-eluting stents vs. bare metal stents at 1 and 2-year follow-up: results from the RESEARCH Registry.

Aims: To assess the cost-effectiveness of sirolimus-eluting stents (SESs) compared with bare metal stents (BMSs) as the default strategy in unselected patients treated in the Rapamycin Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) Registry at 1 and 2-years following the procedure.

Methods And Results: A total of 508 consecutive patients with de novo lesions exclusively treated with SES were compared with 450 patients treated with BMS from the immediate preceding period. Resource use and costs of the index procedure, and clinical outcomes were prospectively recorded over a 2-year follow-up period.

Two-year clinical follow-up of the unrestricted use of the paclitaxel-eluting stent compared to the sirolimus-eluting stent as part of the Taxus-Stent Evaluated at Rotterdam Cardiology Hospital (T-SEARCH) registry.

Aims: To investigate the medium term (2 year) clinical outcome of the use of the paclitaxel-eluting stent (PES) compared to the sirolimus-eluting stent (SES). To date, there are no direct comparative data on the efficacy of these stents over medium term follow-up. Furthermore, a possible late restenotic phenomenon has not been excluded.

Single-vessel versus bifurcation stenting for the treatment of distal left main coronary artery disease in the drug-eluting stenting era. Clinical and angiographic insights into the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital (RESEARCH) and Taxus-Stent Evaluated at Rotterdam Cardiology Hospital (T-SEARCH) registries.

Background: Routine drug-eluting stent (DES) implantation has recently improved outcome in patients undergoing percutaneous treatment of left main (LM) coronary artery. However, even in the DES era, distal LM treatment remains an independent predictor of poor outcome. Whether single-vessel stenting (SVS) or bifurcation stenting (BS) should be performed to optimize treatment of such a lesion is unclear.

Type-D personality predicts chronic anxiety following percutaneous coronary intervention in the drug-eluting stent era.

Background: Anxiety is an often overlooked risk factor in coronary artery disease (CAD). Hence, little is known about predictors of unremitting chronic anxiety in CAD patients. We examined whether the distressed personality (type-D) predicts chronic anxiety post percutaneous coronary intervention (PCI).

Three-year clinical follow-up of the unrestricted use of sirolimus-eluting stents as part of the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital (RESEARCH) registry.

Sirolimus-eluting stents (SESs) have been shown to decrease restenosis compared with bare metal stents (BMSs). Currently, there are limited data on the long-term efficacy of these devices in a real-world patient population. Furthermore, the potential of a late restenotic phenomenon has not yet been excluded.

Accuracy of stress Tc-99m tetrofosmin myocardial perfusion tomography for the diagnosis and localization of coronary artery disease in women.

Background: Earlier studies have suggested a modest accuracy of stress thallium 201 myocardial perfusion imaging (MPI) for the diagnosis of coronary artery disease (CAD) in women. The accuracy of stress MPI with technetium 99m tetrofosmin has not been studied in women. The aim of this study was to assess the accuracy of stress Tc-99m tetrofosmin MPI for the diagnosis and localization of CAD in women.

Plasma natriuretic peptide levels reflect changes in heart failure symptoms, left ventricular size and function after surgical mitral valve repair.

Background And Aim: N-terminal pro-B-type natriuretic peptide (NT-proBNP) has diagnostic and prognostic value in patients with heart failure. The present prospective study was designed to assess whether changes in NT-proBNP levels after surgical mitral valve repair reflect changes in heart failure symptoms and changes in left atrial size, left ventricular size and left ventricular function.

Methods: The study population consisted of 22 patients (mean age: 62.

Prognostic value of exercise stress technetium-99m-tetrofosmin myocardial perfusion imaging in patients with normal baseline electrocardiograms.

Exercise stress electrocardiography is the recommended method for cardiac evaluation of patients with normal electrocardiograms (ECGs). There are no data to indicate an independent value of myocardial perfusion imaging (MPI) in predicting mortality in these patients. This study assessed the value of exercise stress MPI in predicting mortality in patients with normal baseline ECGs.